Healthcare Provider Details

I. General information

NPI: 1922203298
Provider Name (Legal Business Name): MIDWEST AUDIOLOGY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N GALENA AVE STE 120
DIXON IL
61021-2115
US

IV. Provider business mailing address

109 POOLER AVE
DEKALB IL
60115-4626
US

V. Phone/Fax

Practice location:
  • Phone: 815-288-1111
  • Fax: 815-288-1111
Mailing address:
  • Phone: 181-575-1224
  • Fax: 815-754-0993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. REBECCA RAMSEY FOGEL
Title or Position: PRESIDENT
Credential: M.A., CCC-A
Phone: 815-288-1111